Disclaimer: I certify that I am authorized by my company to request and receive
information from ShelterPoint Life regarding Third Party Sick Payments to employees
of my company. I understand and agree that ShelterPoint Life is providing this preliminary
third party sick payment report ("Report") for informational purposes only and this
Report is NOT intended to be filed with any government authority or used as the
basis for end-of-year payroll filings. I acknowledge that this Report may not reflect
the total payments to be made for the applicable tax year, and that any fees and
penalties incurred as a result of the use of this Report will be the sole responsibility
of my company, and ShelterPoint Life shall have no liability to my company of any
kind whatsoever.
By pressing the "Submit" button you acknowledge the above statement and wish to
continue.
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